Improving patient quality remains a top priority from the perspectives of both patient outcomes and cost of care. This continuing threat to patient safety has resulted in ever increasing numbers of patient safety initiatives. As these pressures increase, hospitals are commonly reporting that nurses and physicians are facing competing priorities and limited time and staff to devote to such initiatives. In this proposal, we will deveop an innovative decision support methodology to help participants in quality improvement initiatives prioritize which quality activities would demonstrate the highest likelihood for succes. In order to accomplish this, we will first characterize the concepts and framework that would be included in a decision making model for the purposes of prioritizing a patient safety focus in the domain of healthcare associated infections. We will then build a quantitative decision making model for prioritizing initiatives related to the four most common types of healthcare associated infections: surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia and catheter-associated urinary tract infections. Finally, we will evaluate the construct validity of the patient safety harms prioritization decision making model using expert interviews and decision maker satisfaction. At the conclusion of our work, we will have created a decision support methodology that can be used for evaluating alternatives and contributing to discussions on how quality initiative endeavors should be pursued. As hospitals continue to struggle with improving quality of care despite limited resources, such a formal decision support mechanism would be a template for other prioritizations of patient quality initiatives.